Select Committee on Work and Pensions Written Evidence

Supplementary memorandum submitted by Prospect

  1.  Increasing public and political expectations that the HSE should influence occupational health and safety so injury and illness rates fall conflict with continued pressure to reduce public spending. We fear that further reductions in the HSE's budget will damage the effectiveness of the HSE and result in an increased burden on the taxpayer through higher accident rates.

  2.  In each of the four areas outlined by the Committee, our overall assessment is as follows:

    —    Legislative background: The current legislative background is robust as it is built upon a tradition of consensus and providing a proportionate response to health and safety risks. However, the effectiveness of the legislative background relies upon adequate funding and the professional of HSE staff.

    —    Resources: The current squeeze on HSE funding, which has almost halved the proportion of GDP spent on the HSE since 1992, ensures that the HSE simply does not have sufficient funds to meet its obligations as a health and safety regulator. A substantial increase in funding, no less than 20% and a further 1,000 staff, is required to meet public and political expectations. HSE funding should also have sufficient flexibility to allow the organisation to respond to unexpected major safety incidents, such as Buncefield, and to respond to changes in public priorities, such as concern over construction fatalities.

    —    Inspection, enforcement and prosecutions: The regular inspection of employers by skilled, experienced inspectors with enforcement powers remains the most effective mechanism for improving occupational safety so long as those inspectors have sufficient specialist, policy and scientific support. Penalties for criminal breaches of health and safety legislation are relatively low and give a misleading signal that society does not take death, injury and disease at work as seriously as other forms of business malpractice.

    —    Hazardous occupations, migrant workers and occupational health: Additional resources are needed to tackle the problems in construction, agriculture, chemicals and off-shore oil production by improving the access of inspectors to sites. The lack of resources for construction and agriculture places many migrant workers at increased risk of industrial injury. The decline in occupational health provision by the HSE is baffling given the increased impact of ill-health at work and significant additional investment in the HSE's occupational health service would have considerable benefit to employers, workers and the economy.

  3.  In addition, we believe that the current debate over regulation should focus on what HSE interventions deliver most benefit to employees, employers and society as a whole. Whilst the principles of a proportionate approach and a tripartite partnership between the HSE, employers and unions are well-established, we still believe that these values underpin an effective system of occupational health and safety and help create an intelligent approach to regulation that is ignored by the often sterile debate between light and heavy forms of regulation. In our experience, good and efficient employers see the creation of a safe workplace with a strong commitment to health and safety as being more appropriate than mere compliance with legislation.

  4.  Prospect represents over 100,000 professional, technical, scientific and managerial staff across the economy but concentrated in the civil service, energy utilities and the nuclear sector. We are the largest union in the HSE representing over 1,700 inspectors, policy advisers, scientists and managers. With our experience of representing other groups of staff in hazardous industries, we believe that we understand the views of both regulators and professional staff subject to regulation.

Section A: Legislative background

  5.  Our experience of applying and enforcing legislation based on a test of reasonable goal-setting is that such legislation is by definition proportionate. However, there is a danger of continued over-implementation by dutyholders due to fear of HSE and civil litigation. On occasions independent consultants have taken advantage of this lack of understanding to sell health and safety management "solutions" to small businesses that are not always appropriate rather than focusing on what is a proportionate response applicable to a particular business.

  6.  This potentially places a substantial cost on business: however we do not believe that diluting legislation is a suitable response since this merely transfers the cost from employers to individual employees and to society as a whole. Moreover the emotional trauma caused by industrial accidents and disease is such that it is reasonable to err on the side of prevention.

  7.  The effectiveness of legislation often is as reliant upon the mechanism for implementation as the drafting of legislation. In the case of occupational health and safety, for legislation to be effective, we believe that high-quality inspection and advice from HSE inspectors and other staff such as policy advisers and scientists is vital to ensure that employers and their staff respond appropriately to both the constraints placed by legislation and to create an effective corporate health and safety culture that is appropriate to the specific business. The combined professional judgment of HSE staff, managers with responsibility for health and safety and employees is key to ensuring that the best value is obtained from the current legislative framework. Whilst there is continued scepticism about the value of health and safety rules, mainly due to often well-intentioned but futile over-reaction to legislation, there is simply no evidence to suggest that organisations which skimp on health and safety are more efficient and profitable than their peers: indeed the bulk of evidence points to a positive correlation between safety standards and profitability.

  8.   The regulatory burden on business: Overall the health and safety regulatory burden on business is proportionate. The majority of generally applicable health and safety related regulation in place in the UK is derived from European directives. In translating these directives into domestic legislation the UK has opted for goal setting rather than prescriptive legislation. The regulations are generally couched in terms of: what is suitable and sufficient; what is appropriate; and what is adequate. The clearest example is the regulation that most directly requires administration of health and safety statutory duties, ie regulation 5 of the Management of Health and Safety at Work Regulations 1999 (MHSW 1999).[55]

  9.  The regulation encourages a proportionate approach from the regulator. We feel that this reflects the spirit of the 1974 Health and Safety at Work Act where duties are defined as what is reasonably practicable or practicable.

  10.   EU legislation: We do not believe that EU legislation is gold-plated as examined by Lord Donaldson in 2006 and we broadly agree with the conclusions of the 2006 Donaldson Report. However, it is important that the HSE can respond to concerns from all stakeholders regarding prospective European legislation that is commonly feared to impose unnecessary duties. Therefore the HSE needs to develop expertise and relationships that enable the UK to best shape European health and safety legislation. This requires the HSE to retain sufficient skilled and experienced inspectors, scientists and policy experts. Current funding policy seems designed to prevent this and to increase the costs on business by not responding fully to proposed EU legislation.

  11.   Business Guidance: Effective safety regulation is dependant on two factors:

    —    Dutyholders' acceptance that they require advice and guidance; and

    —    The authority, accuracy and availability of that advice and guidance.

  12.  Currently the HSC/E produces a wide range of authoritative, internationally respected guidance. These range from general Approved Codes of Practice, which by their nature and legal status are not industry or situation specific through general guidance to some highly specific guidance and information. Employers and unions place a high value on this advice as the HSE has traditionally consulted widely on guidance and employed recognised experts with sufficient credibility with industry. We are concerned that this position is compromised by funding constraints as the HSE's wide professional credibility across occupational health and safety is a major contributor to safety at work. We emphatically reject Judith Hackett's (Chair of the HSC) suggestion to the Committee on 28 November that "HSE can not, clearly, be expert in all of the areas that we regulate": the HSE should retain sufficient skilled policy and scientific staff to provide expert advice and guidance across the full range of occupational health and safety.

  13.  Our experience of practical enforcement and advice suggests that employers and unions place a high value on the advisory role of Inspectors with access to expert specialist inspectors, policy and scientific advice. This key interface with the HSE is extremely valuable and effective: employers place a very high value on the ability of inspectors to offer practical guidance that simplifies much of the detailed printed advice available.

  14.   Corporate Manslaughter and Corporate Homicide Act (2007): The Act does not impose any new duties upon employers but we believe that it will encourage improvements amongst better performers due to increased attention of finance directors, insurers and legal advisers. For the Act to spur improvements in safety management amongst mediocre and poor performers, expert advice and robust enforcement will continue to be necessary so Directors are aware of their duties under the Act. Further cuts in HSE funding will remove this ability to implement the Act despite the clear wish of Parliament for Directors to be held more accountable. Prospect's concern is that a few high-profile offenders will be targeted and thereafter the legislation will only be used sporadically

  15.   Voluntary guidance for Directors: We do not believe that it would be desirable to produce further general guidance for Directors when there is a lack of consensus over change except to reinforce the role of employee safety representatives: these reps are a key element of any successful safety culture and their greater involvement in safety issues is likely to benefit society by improving safety performance.

  16.  However, the best form of advice for Directors remains the informal enforcement undertaken by inspectors who have developed the professional credibility and workplace relationships to provide useful specific advice that is proportionate. The success of this approach to enforcement is built on two major principles: firstly, the maintenance of a highly skilled inspectorate with sufficient policy and scientific support to retain professional credibility: and secondly the retention of the power of formal enforcement by the HSE staff providing the advice. Prospect's experience confirms that physical inspection by inspectors with a remit and professional expertise to conduct a full inspection is a vital mechanism for ensuring that Directors and mangers get the guidance they require to manage health and safety. Funding cuts would reduce this support available to employers and their staff.

  17.   Local Authority Planning: Given that in practice, the HSE is consulted over land use where there are significant safety issues, the only significant changes required are: a commitment to consult the HSE over societal risks where a single incident could injury a large number of people; a firm commitment to continue to consult the HSE over nuclear installations and continued funding for the HSE to undertake this valuable role that does not often have an immediate impact on injury and illness rates.

Section B: Resources

  18.  The current level of HSE resources is not sufficient to meet the expectations held by the public and on occasions by employers, unions and politicians. In the absence of a full public debate over the appropriate level of occupational health and safety advice and enforcement, the HSE remains condemned to reductions in funding to meet overall spending limits which in the three years of the next Comprehensive Spending Review from March 2008 establish a 16.8% reduction in funding of the HSE's parent department, DWP. This reduction would hamper the HSE to the extent that its and the Government's credibility in maintaining, let alone improving, health and safety standards would be lost.

  19.  Despite media myth and hype about an intrusive HSE, its cost needs to put in context: there are fewer inspectors employed in Great Britain than there are traffic wardens in Greater London.[56] The HSE's budget is lower than that of a medium sized police force such as Avon and Somerset.

  20.  Given the substantial financial and emotional costs of occupational accidents and disease, we believe that Government should abandon some of its banal deregulatory rhetoric in favour of assessing the effectiveness of the HSE's work and the benefits of greater investment in prevention to reduce those substantial costs. There is clear evidence that shows that the prevention of unsafe, and often criminal, acts at work has a far greater financial benefit to society than investment in mitigating the effects. Evidence suggest that the total cost of poor occupational health and safety is over £20 billion each year! Whilst the HSE is not the only mechanism for addressing this negligence, we believe that there is significant gearing with a small investment in greater inspection, advice and enforcement delivering a far more substantial reduction in the costs of accident and disease.

  21.  We believe that the HSE's funding can be assessed in two ways: the proportion of GDP devoted to health and safety; and meeting public expectations.

  22.  Maintaining the proportion of GDP spent on the HSE would ensure that the cost of the service did not grow faster than the capacity of the economy to support it. In 1987, the HSE employed 3,500 staff and spent 0.024% of UK GDP: by 1992 this had increased to 4,500 staff and 0.033% of GDP. By 2007 the HSE had reduced to fewer than 3,300 staff spending 0.017% if GDP with further cuts anticipated up to 2011. The effectiveness of the HSE has mirrored the changes in funding with the greatest benefits occurring as the staff and budgets increased and the plateauing of accident rates, with increases in some key sectors such as construction, occurring as the investment was run down. Maintaining the proportion of GDP spent on the HSE would imply at least a return to the 1987 level of 0.024% spend and an increase in staff numbers to 4,500.

  23.  Evidence does not suggest that funding should have been reduced as the need for the HSE disappeared. Whilst the type of work conducted by the HSE has changed as the economy has evolved, this has not reduced the need for professional expert advice and enforcement. Indeed some of the current objectives such as occupational health and the management of attendance require even greater input from suitably skilled and experienced inspectors.

  24.  Alternatively, we could examine the expectations upon the HSE through the questions set by the Committee that forms the rest of Section B.

  25.  The HSE's objectives as the health and safety regulator and meeting its PSA targets: The HSE clearly is under-resourced and cannot meet its internal 60-40 split between preventative and reactive inspection due to a lack of funds. The inability to achieve internal targets for preventative work threatens the HSE's overall ability to reduce accident and injury rates as required by the PSA targets. As this split is deemed necessary to meet public expectations over occupational health and safety, we believe that HSE funding should increase to ensure that 60% of inspection could be preventative.

  26.  More disturbingly, even though the HSE has sacrificed some preventative work to respond to incidents, the HSE is increasingly unable to meet the HSC's criteria for accident investigation. As a tripartite organisation the HSC acts on the basis of consensus so in 2004 less stringent criteria for investigation, that for example exclude amputations of fingertips above the first knuckle, were introduced with the acceptance of unions, employers and Government. Since 2004, the number of serious accidents that the HSE is simply unable to investigate has almost increased by two-thirds from 188 in 2004-05 to 307 cases in 2006-07. This high level of non-investigated accidents is due to a lack of resources.

  27.  The HSE is also unable to meet occupational health targets due to a lack of sufficient skilled staff. The bizarre run-down of the HSE's occupational health capacity over 15 years when improving occupational health has become a more important public priority is described in more detail in Section D.

  28.   Budget efficiency: Due to the highly uncertain nature of future public funding it is almost impossible for the HSE to manage its budgets efficiently. At a time when the HSE has improved financial performance by shedding staff, the organisation has generated a surplus in the current financial year presumably because the HSE fears further substantial funding cuts from 2008.

  29.  Like any organisation in the public or private sector, the HSE continues to seek greater efficiency. Our fear is that some of the current initiatives adopted by the HSE simply reduce cost rather than improve efficiency at a time when the demands upon the HSE are increasing. We also believe that the PFI arrangements for the Bootle headquarters and the Health and Safety Laboratory at Buxton are financially inefficient.

  30.  The current How and Where We Work programme appears to contemplate cost savings through the accelerated shift of policy staff out of London, the introduction of hot-desking in regional offices, a reduction in the number of support staff and a review of the regional office structure. We are concerned that the residual London policy presence will be inadequate and will increase travel costs as policy staff have to travel from other locations to London for meetings.

  31.  As a national organisation, the HSE is required to provide a robust service across Great Britain so we are opposed to any further diminution of the HSE's regional office structure since this will simply lead to increased travel, which reduces the time that inspectors and other specialists spend on productive work. In addition we are sceptical about the benefits of hot-desking that appear to sacrifice productivity to reduce the costs of running the HSE's estate in response to a decline in Government funding. We fear that the off-site archiving of records and a reduction in the informal interactions between inspectors reduce the effectiveness of the HSE.

  32.  Whilst we recognise that the HSE wishes to minimise the impact of recent funding cuts on front-line staff, this is not achieved by simply reducing the number of support staffing the absence of more efficient ways of providing that support. The HSE employs policy and support staff to enable inspectors to make more efficient use of their time: for example asking inspectors to perform basic administration tasks is a method to make administration less efficient rather than to increase productivity.

  33.   Additional investment: The HSE retains public confidence by addressing the full range of occupational health and safety issues. Given the impact of injury and disease, the emphasis should be on increasing preventative work and developing expertise to deal with new priorities. Given the decline in the HSE's occupational health capacity, then significant further investment in this area is required. However, investment in preventative inspection should recognise that such work is reliant upon high-quality policy and scientific support.

  34.  The partnership principles that underlie the HSC/E suggest that the HSE should have significant autonomy to pursue issues that are given priority by stakeholders without significant political interference: in reality occupational health and safety remains a key objective of Government through the DWP. Therefore it remains in the public interest for the HSE to respond to unexpected emergencies such as the Buncefield oil explosion and the Foot and Mouth outbreak at Pirbright as well as a greater emphasis on tackling occupational safety issues such as the rise in construction fatalities. However, given current and future budgetary constraints we believe that a contingency fund should be established to enable the HSE to respond promptly to such changes driven by events outside its control and that this fund should be supplemented by additional funding when significant additional resources are required as in the case of the response to the unacceptable level of construction fatalities.

  35.  Given the level of political and public expectation over occupational health and safety, we believe that an increase in funding back to 0.024% of GDP and an additional 1,000 staff is the minimum level required to match growing expectations of performance and the increasing complexity of issues faced by the HSE.

Section C: Inspection, enforcement and prosecutions

  36.  Evidence from the HSE and elsewhere shows that enforcement remains the most effective form of intervention for reducing accident rates. The reduction in the frequency of inspection correlates closely with the end to a fall in accident rates and there is no strong evidence to show that another cultural factor is the cause of this decline in HSE effectiveness.

  37.  Small and medium enterprises tend to rely on external interventions to ensure compliance. Although they recognise that they have a duty to comply with HSE regulations and guidance, in practice they will normally believe they are compliant until someone credible, such as the HSE, inspects and informs them otherwise. We do not believe that any more than a small minority of employers deliberately breach health and safety law and the issue is one of finding a form of regulation that improves knowledge and compliance.

  38.  We believe that the use of skilled experienced inspectors with enforcement powers is one of the key strengths of the British system of regulating health and safety. Naturally such effectiveness requires efficient policy, scientific and administrative support. We are extremely sceptical about support from senior HSE management for the use of intermediaries by the HSE to provide guidance on criminal law.

  39.  The use of inspectors with enforcement powers has considerable credibility with both employers and unions; and we believe that a policy of using other bodies to provide advice has led to an unacceptable decline in enforcement in the past. We believe that the HSE does not fully value the effective working relationships between inspectors and duty-holders, in particular a high reliance on inspectors as a source or as a gateway to advice does not suggest that an organisation does not have a robust safety culture. Often the credibility of other forms of intervention relies on an appreciation by an employer that these supplement rather than substitute for the role of the inspector.

  40.  Effective inspection and enforcement also relies on trusting the professional judgment of inspectors. Under the FIT3 programme the HSE intended to restrict the remit of inspections to key targets such as slips and trips, working at height and manual handling and any other issue of obvious concern. This may have reduced the length of inspections but it could override the professional judgment of inspectors who use their professional judgment to consider other issues that are likely to be important dependent upon the specific circumstances of the site, the organisation and its staff.

  41.   Prevention and Enforcement: It remains difficult to separate issues as the two are intimately linked. Much enforcement work is actually generated by preventative activity so we are not convinced that inspectors should concentrate on either prevention or enforcement. Our support for the 60-40 split between preventative and reactive work is explained in paragraph 25 of this submission.

  42.   Penalties: Given the relatively low level of fines for breaches of health and safety legislation compared to other forms of corporate malpractice such as breaches of data protection and anti-competitive behaviour, we believe that the current level of penalties creates the impression that the Government is less concerned about breaches of health and safety legislation. We would support a call to increase maximum fines to a fixed proportion of company turnover to penalise the rare employer whose unacceptable management of health and safety harms individuals and society.

  43.   Crown immunity: Whilst in practice, most Crown employers take health and safety seriously, there is no compelling reason why Crown immunity should remain. Indeed it could give the impression that the Government places a low priority on health and safety by seeking a wide-ranging exemption of its own activities from criminal prosecution. We welcome the removal of crown immunity as defence against corporate manslaughter and would welcome its total removal but do not see this as a major priority at present for the HSE.

  44.   Local Authorities: Whilst there is some prospect of developing further joint working with local authorities and improving their involvement in HSE policy, the scope for joint inspection warrants is limited due to the differences in skills of local authority enforcement staff, the substantially different priorities of local government and the severe constraints on local authority spending. We do not believe that transferring work to local authorities is a solution to central government under-resourcing of the HSE.

Section D: Hazardous Occupations

  45.  Prospect believes that more hazardous industries such as construction, nuclear, off-shore oil and gas need a deeper inspection regime which uses professional expertise to recognise the higher potential level of risk and the risk that consequences of an incident will be more significant than in other sectors. However, the use of safety cases runs the risk of reducing effective practical inspection. Migrant workers pose significant issues but these are related to their disproportionate employment profile with significant concentrations in agriculture and construction. Occupational health is a serious case of failure due to the run-down of the HSE's capacity to deal with occupational health issues.

  46.   Construction: The rise in construction fatalities is a national disgrace. Even with some statistical adjustment of figures the fact that construction workers are four times more likely to be killed at work is simply unacceptable. The evidence suggest that much more work needs to be done on individual construction sites to improve management leadership, safety knowledge and compliance with heath and safety regulations. In these circumstances, a substantial increase in the number of skilled and experienced construction inspectors is necessary to ensure that safety standards can be addressed on individual sites. The support of the industry and the Secretary of State for action is welcome but there is a fundamental issue of resources as this is one sector where routine site inspection that addresses the full range of construction issues is vital.

  47.   Off-shore work: Whilst the HSE has developed a series of initiatives with the offshore sector since the Cullen Report, it is misleading to suggest that here are no significant issues with offshore safety. Due to the aging life of offshore assets and the global skills crisis in oil and gas production, the already technically complex offshore industry faces a wider set of challenges as high oil prices prolong the life of existing oil installations. This places a higher premium on the professional skills of our members

  48.  Whilst safety cases have considerable value in preventing a repetition of the design faults that contributed to the Piper Alpha tragedy, their existence and the high level of mandatory inspection has reduced the ability of the HSE's Offshore Directorate (OSD) to undertake other initiatives at a time when the complement of OSD inspectors has reduced from 200 in 1994 to fewer than 120 today. At current salary levels, OSD could struggle to maintain staff numbers given that it has an aging workforce. Given the prospect of a longer life for many offshore assets, we believe that more inspectors should be employed to make site inspections to supplement the use of safety cases.

  49.  Given the severe financial and moral consequences of a major accident or shut-down due to faulty installations, the oil industry is prepared to pay for a higher quality of inspection by making OSD salaries more competitive as the key issue is the quality of judgments made by inspectors not the frequency of inspection.

  50.   Chemicals: The Buncefield incident suggests that the current system of safety regulation could be improved as the incident could have resulted in a substantial number of deaths, we would be happy to comment in more detail once the Buncefield report is released as the collection of evidence should demonstrate some practical steps to improve the safe regulation of the chemicals sector which contains some elderly assets.

  51.  As with offshore oil and gas, we appreciate the value of "permissioning" regimes where operators have to assure the HSE and environmental regulators that they will design out hazards and operate in accordance with their safety case. Due to financial constraints, the production and approval of safety cases has reduced the amount of time that the HSE can devote to site inspection and audit. The Buncefield report should start a debate on will demonstrate whether this approach is adequate but we believe that a better balance between safety case permissioning and site inspection would improve safety performance.

  52.   Migrant Workers: It is unclear whether or not migrant workers are more exposed to the risk of occupational accidents, but our belief is that this is likely. Moreover, we believe that HSE does not do enough to protect migrant workers from health and safety risks as they are more likely to work in areas of the economy such as agriculture and construction where inspection is poor even before the specific issues raised by the different training experiences, diverse safety cultures and potential problems with communication that affect migrant workers are considered.

  53.  Resource constraints have affected the time that inspectors can devote to agriculture and construction: given the relative lack of political lobbying power of their workforces, these sectors have been neglected in favour of other priorities. The impact has been a deterioration in the time spent on inspection: whilst working with major employers in both sectors has some benefits, the large extent of sub-contracting means that effective site inspection is especially important and this has suffered due to financial pressure on the HSE.

  54.   Occupational Health: Occupational ill-health has a huge impact on the UK economy. The Labour Force Survey 2006-07 suggests that around 2.2 million people suffered from ill health that they thought was work-related, of which 646,000 were new cases in the preceding 12 months. Lack of HSE resources restricts the prevention of ill health, and there is very poor enforcement of legal provisions relating to ill health. Prosecutions for causing ill health in the workplace are very rare, if they get investigated at all.

  55.  When occupational health provides the dual benefit of individual recovery and the prevention of illness for colleagues, it is strange that it is so neglected. We lag far behind our European partners on occupational health provision: for example, HSE commissioned research[57] showed that only 3% of UK companies provided reasonable levels of occupational health support. Decent provision of expertise in occupational health within the HSE is vital if Britain's position as the poor man of Europe is to change. There are now only around five (full-time equivalent) occupational physicians in HSE, and around 20 occupational health inspectors down from around 60 of each in the early 1990s. HSE's Corporate Medical Unit (CMU) is so depleted that it is no longer able to provide basic cover on occupational health advice and prevention, nor provide the leadership role it once did to the occupational health community in Great Britain. This decline in HSE's medical expertise presents a serious risk to Government credibility on preventing occupational ill health.

  56.  Occupational health professionals employed within the Health and Safety Executive are needed to oversee the active monitoring and reviewing of occupational ill health with the aim of prevention, of identifying weaknesses in employer provision, and to define and maintain standards. HSE's occupational health physicians and inspectors have much needed skills, combining expertise in occupational medicine with a detailed understanding and experience of health and safety law.

  57.  Prospect supports the call for a greater focus on rehabilitation as a means by which employers can retain the expertise and skills of staff who become ill or injured during their working life, but advises caution about its application. However, the focus on rehabilitation does not detract from prevention. Also the evidence for the effectiveness of resources spent on rehabilitation is somewhat sketchy. DWP Research concluded in 2005 Project RR339 and 342, The Job Retention and Rehabilitation Pilot, showed limited impact of rehabilitation on return to work. The review suggested (which is supported by anecdotal evidence from our members) that the strongest factor in determining length of absence is personal motivation to return to work: this impression is confirmed by the experience of our members.

Section E: Culture and the role of Government

  58.  One of the most disappointing trends in public life has been an increased wish by Government to override the professional judgment of health and safety at the same time as decrying the volume of health and safety regulation as sign of excessive interference in business and commerce. All the evidence suggests that profitability and good safety performance actually work hand in hand.

  59.  Prospect would wish to see a more intelligent approach to HSE regulation based on the following four principles:

    —    the recognition that the principle of proportionate action based on the specific circumstances of each employer delivers an effective system of regulation;

    —    recognition of the value of partnership between the HSE, employers and unions as good practice is dependent upon changing culture;

    —    respect for the professional judgment of inspectors, policy advisers and scientists rather than criticising the HSE simultaneously for not taking enough action to enforce safety standards and for heavy-handed regulation; and

    —    adequate funding.

January 2008

55   MHSW 1999 regulation 5(1) "Every employer shall make and give effect to such arrangements as are appropriate, having regard to the nature of his activities and the size of his undertaking, for the effective planning, organisation, control, monitoring and review of the preventive and protective measures." Back

56   In the Field Operations Directorate for the whole of Great Britain there are around 500 to cover all the inspections, investigations and prosecutions for all manufacturing (except chemicals manufacturing), construction, the health services, education, all local authority activities, Govt departments and agencies, fire and police services, the defence industry and MOD, agriculture, fairgrounds, domestic gas safety, utilities, ports and docks, and others. There are around 80 chemical industries inspectors, 120 in offshore safety, and there are in addition around 180 operational specialist inspectors and engineers. The Nuclear Installations Inspectorate is 35 inspectors short of numbers needed to meet current inspection requirements and would be unable to respond properly to any new build programme. There are more traffic wardens in London than there are inspectors in the whole of HSE's Field Operations Directorate. Back

57   Survey of Use of Occupational Health Support, CRR 445/2002, HSE 2002. Back

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Khasta Bal Dar ...Ek Chota Khasta...Sakhat BiscuitSakhat Pehika B...Pehika BiscuitKhamiri RotiHalki PistariShehad Wala BanEk Namkeen DashSa Parti SandwichHamburgerBurgerBara SandwichAatay Ki SeviyanGounday Huay Aa...Aatay Ki Bani S...Paneer Ki Bani ...Sehat Bakhsh GhizaZaiqay Men Acha...

Ek Namkeen Dash : ایک نمکین ڈش

1. Sandwich : ایک نمکین ڈش : (noun) two (or more) slices of bread with a filling between them.

Buni Hui Shay : Filling : the yarn woven across the warp yarn in weaving.

Kisi Cheez Ka T..., Qatla : Slice : a serving that has been cut from a larger portion. "A piece of pie"

Roti : Bread : food made from dough of flour or meal and usually raised with yeast or baking powder and then baked. "Did you have bread?"

Kisi Cheez Ka J..., Hissa : Slice : a share of something. "A slice of the company's revenue"

Rukra, Maal : Bread : informal terms for money. "Everybody needs lolly"

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Category Archives: HAY FEVER

Allergy Shots – A Brief Overview

Hay Fever in the Fall

September may be the month to consult an allergy specialist Centreville VA patients turn to, as ragweed pollen counts peak and wreak havoc in allergic individuals in the Washington, DC, Northern Virginia, and Maryland metropolitan area including the following cities in Northern Virginia: McLean, VA, Tysons Corner, VA, Vienna, VA, Fairfax, VA, Arlington, VA, Great Falls, VA, Falls Church, VA, Annandale, VA, Alexandria, VA, Reston, VA, Herndon, VA, Sterling, VA, Oakton, VA, Burke, VA, Manassas, VA, Centreville, VA, Chantilly, VA, Gainesville, VA, Haymarket, VA, Warrenton, VA, Springfield, VA, Dumfries, VA, Culpeper, VA, Ashburn, VA, Leesburg, VA, Purcellville, VA. Ragweed also affects the surrounding Maryland cities such as Bethesda, MD, Chevy Chase, MD, Potomac, MD, Great Falls, MD, Gaithersburg, MD, Rockville, MD, Darnestown, MD, Germantown, MD, Olney, MD, Silver Spring, MD, Wheaton, MD, College Park, MD, Hyattsville, MD, Beltsville, MD, Bowie, MD, Clinton, MD, Annapolis, MD, Columbia, MD, and Baltimore, MD. In the DC metropolitan area, ragweed begins to pollinate in mid-September and ends at the first frost which is usually at the end of October.

What is Ragweed?
As an allergy specialist Centreville, VA has to offer might attest, ragweed is a tough and hardy soft-stemmed weed that can grow well along roadsides, riverbanks, vacant lots, and fields. It belongs to a genus called Ambrosia and there are 17 different species of ragweed. The height of the plants generally range from about 3 inches to 12 feet.

The plants mature in mid-Summer and produce small flowers. Warmth, decreased humidity, and active breezes after sunrise help create the ideal environment for ragweed flowers to release their pollen. Each individual plant can release up to one billion pollen grains. Though most of the released pollen stays in the general area, some grains can travel as many as 500 miles in dry and windy conditions. This helps explain why pollen counts are usually lowest on rainy days and cool mornings. Individual plants pollinate only for one season but the seeds survive in the soil from year to year producing fresh crops each year. Over the past decade, the EPA has noticed a prolonged ragweed season in the Washington, DC area. Climate changes and increased carbon dioxide levels in the atmosphere may play a role in this prolongation of the ragweed season.

How Does it Cause Allergies?
Though ragweed pollen is generally harmless, in a genetically susceptible individual, the immune system can mistake it as potentially dangerous invader and mount a defensive attack. This process triggers antigen (ragweed) vs. antibody (immunoglobulin) reactions on exposure, resulting in the release of chemical mediators like histamine which are responsible for the classic annoying hay fever and/or asthma symptoms. An estimated 15% of all Americans are sensitive to ragweed. As an allergy specialist in Centreville VA may explain, the risk of developing sensitivity is higher in people with other types of allergic disorders like eczema (i.e., atopic dermatitis) and asthma and in those with a family history of similar disorders.

What are the Symptoms?

  • Itchy nose, eyes, throat, and ears
  • Watery and/or red eyes
  • Runny nose, nasal congestion, and/or post-nasal drip
  • Sneezing
  • Post nasal drip and/or throat irritation
  • Cough, chest tightness, wheezing, and/or shortness of breath
  • Sinus pressure and/or headaches
  • Fatigue
  • Snoring
  • Clogging and/or popping of the ears

Though “hay fever” is the term commonly in vogue, “seasonal allergic rhinitis” is a more accurate description of the condition.

Oral allergy syndrome (i.e., Pollen-food allergy syndrome) is a condition where one experiences itching of the lips, mouth, and/or throat after eating fresh fruits and/or vegetables. The cause of the phenomenon is a cross-reactivity between similar proteins in the pollen and the fruits and/or vegetables. Ragweed pollen typically cross-reacts with melons, bananas, cucumbers, avocados, kiwi, and zucchini.

How is it Diagnosed?
An allergy specialist Centreville, VA residents turn to for help will take a thorough history and physical examination. A simple allergy skin test can be performed by applying the diluted allergen (ragweed) to the surface of the skin. A raised, itchy, red bump after 15 to 20 minutes at the site of application confirms sensitivity to the allergen. Alternatively, a blood test can also be done.

What Can Be Done to Minimize the Symptoms?

  • Keeping track of pollen counts and avoiding outdoor activities to the possible extent on high pollen days.
  • Keeping the windows closed in homes and automobiles and running air-conditioning.
  • Changing clothes and showering before going to bed.

If the symptoms are bothersome in spite of environmental control, several medications like antihistamines, nasal sprays, eye drops, and inhalers may be needed. Keep in mind that most medications only mask the symptoms without treating the underlying cause and can cause undesirable side effects. Many individuals also become tolerant to an antihistamine and what had helped initially becomes ineffective.

Allergen immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization) is a process of increasing tolerance to the allergens by exposing the immune system to gradually increasing the concentrations of the antigen at regular intervals. This process has the potential to offer long-term benefit to many people who experience bothersome symptoms every year. Allergy shots are effective in 80-85% of individuals and have been used in the U.S. for over 100 years.

A Centreville, VA allergy specialist at Black & Kletz Allergy can treat both adults and children with ragweed allergies in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We have convenient offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA that all offer on-site parking. The Washington, DC and McLean, VA offices are Metro accessible and there is a free shuttle between the McLean, VA office and the Springhill metro station on the silver line. Please call us for an appointment or alternatively you can click Request an Appointment and we will respond within 24 hours by the next business day. We can also answer your questions and concerns about other allergic and immunologic disorders, since we have been providing allergy, asthma, and immunology care to the local community for over 50 years. If you’re looking for an allergy specialist Centreville, VA patients recommend, turn to a board certified allergist at Black & Kletz Allergy.

Can Clogged Ears be Caused by Allergies?

The simple answer to this question is yes.

Eustachian tube dysfunction is a condition where the the eustachian tubes of the middle ear do not open and close the correct way.  The eustachian tubes are small tubes that go from the middle ear (the part of the ear behind the eardrum) to the back of the throat.  There is one eustachian tube for each ear.  The eustachian tubes are about 1 1/2 inches long and regulate the air pressure between the middle ear and the atmosphere outside the ear.  The eustachian tubes also serve the purpose of draining fluid and mucus from the middle ear.  Normally, the tubes are closed.  When there is an increase in atmospheric pressure ( e.g., high altitudes, deep water) people typically will intentionally swallow, yawn, or chew gum in order to force the eustachian tube open which will cause an equalization in pressure.  If someone is unable to equalize this pressure difference, one may experience ear pain, a clogged or blocked feeling of the ears, decreased hearing, ringing of the ears (tinnitus), a fullness of the ears, popping of the ears, and/or dizziness.

There are a variety of causes of eustachian tube dysfunction.  Swelling of the eustachian tubes can occur due to allergies (i.e., allergic rhinitis, hay fever)upper respiratory infections (URI’s), and sinus infections.  The swelling causes the tubes to stay closed, preventing them from opening with the normal everyday functions such as swallowing and yawning.  As a result, a pressure difference occurs between the middle ear and the outside atmospheric pressure causing the symptoms of eustachian tube dysfunction to develop.  One may complain of ears that are painful, blocked, full, popping, etc.  Fluid may also collect in the middle ear which can further increase one’s symptoms.  In addition, the fluid can get infected which will often lead to ear infections (otitis media).  Note that the length of the eustachian tubes is shorter, and thus more easily blocked, in children than in adults, predisposing them to a higher risk of ear infections; this is a reason to see a pediatric allergist here in McLean, Manassas or Washington, DC as soon as possible. /2015/08/04/can-clogged-ears-be-caused-by-allergies/ /2015/08/04/can-clogged-ears-be-caused-by-allergies/ /2015/08/04/can-clogged-ears-be-caused-by-allergies/ Cigarette smoking, enlarged adenoids, and obesity are other factors that can predispose and/or cause eustachian tube dysfunction.

As mentioned above, allergies play an important role in causing eustachian tube dysfunction.  Allergic rhinitis (hay fever) is a condition where there is inflammation and swelling in the nasal and sinus regions due to an allergen such as pollen, dust mites, molds, and animals.  It is the swelling component of this allergic condition which contributes to the symptoms of eustachian tube dysfunction.

The board certified allergists at Black & Kletz Allergy have been diagnosing and treating children and adults with “clogged ears” for over 50 years in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  Diagnosing and treating the underlying condition, which often is due to allergies, is the primary way to alleviate the “clogged ears.”  There are numerous allergy medications (i.e., decongestants, nasal corticosteroid sprays, antihistamines), as well as allergy immunotherapy (allergy shots) that can be utilized in order to treat and/or prevent “clogged ears.”  If you suffer from these symptoms or other allergy symptoms, please call any one of our 3 convenient office locations in the DC metro area.  We have offices in Washington, DC, McLean, VA, (Tyson’s Corner, VA), and Manassas, VA.  All 3 offices have on-site parking and the Washington, DC and McLean, VA locations are Metro accessible.  You can also click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy is dedicated to help you get relief from your allergy symptoms in a caring professional environment.

Tree Pollen Allergies in the Washington, DC Metropolitan Area

Spring is rapidly approaching in the Washington, DC metropolitan area and that means many people will be suffering from hay fever (allergic rhinitis).   In the early Spring, tree pollen is mainly responsible for the symptoms that cause hay fever.

There are of course molds in the air simultaneously, but they are always present in Washington.  In the DC area, trees usually begin to pollinate at the end of February, peak in mid- to late-April and continue to pollinate through late May and occasionally through early June.  Some of the first trees to pollinate in this area include cedar, maple, elm, alder, birch, and poplar.  Later in the season, the predominant tree that causes problems for individuals with tree pollen allergies is the oak tree.  Other tress that pollinate in this later time frame include hickory, walnut, and pine.

It is interesting to note that, in general, people are not allergic to flowering trees (i.e., cherry tree, dogwood tree).  Many people think they are allergic to flowering trees because they develop allergy symptoms when these trees are in bloom, however, it is usually not due to these trees, but due to other non-flowering trees that happen to pollinate at the same time.  Nature is behind this sleight of hand trickery.  Flowering trees have pollen that is fairly heavy in weight.  Since the pollen is heavy, it is not easily wind-disbursed and as a result, individuals do not breathe in the pollen and thus do not become sensitized to these pollens.  The flowers are present in order to attract insects such as bees.  When the bee lands on the flower, the pollen sticks to the abdomen of the bee.  The bee will then fly to another flower of another tree and the pollen will intermingle with that flower.  It is by this method that cross-pollination is achieved, made possible by the aid of the bees.  Non-flowering trees such as cedar, maple, elm, alder, birch, poplar, oak, hickory, walnut, etc. have very light weight pollen.  These pollens are easily wind-disbursed.  It is these wind-disbursed tree pollens that individuals breathe in and become sensitized to, that are the cause of hay fever symptoms in sensitized people.  It just so happens that people develop their hay fever symptoms at the same time when the flowering trees bloom.  People then associate these flowering trees with their symptoms and blame their symptoms on the wrong trees.

The symptoms of tree pollen allergies are the classic symptoms of hay fever.  They can include any or all of the following:  runny nose, stuffy nose, post-nasal drip (which can lead to a sore throat, hoarseness, and/or cough), sneezing, itchy eyes, watery eyes, red eyes, puffy eyes, itchy nose, itchy throat, sinus pressure and/or pain, wheezing, chest tightness, cough, and/or shortness of breath.

The following are some measures that can be taken to reduce one’s exposure to the tree pollen in the Spring besides living in a “plastic bubble:” It is advisable to keep one’s windows and sunroof closed.  It is advisable to turn on the air conditioner and change air filters regularly (about once a month).  Use the re-circulate feature in the car so that the air is not coming into the vehicle from the outside.  Choose an automobile that has a filter in its air conditioning unit, if possible.  Avoid yard work and mowing lawns.  If a person needs to do yard work, wear a filtration face mask in order to diminish exposure to the pollen.  If one goes outdoors, shower, wash one’s hair, and change one’s clothing upon returning home to decrease pollen exposure.  Wash your pets regularly and avoid close contact with a pet that goes outdoors during the pollen season since they carry tree pollen on their coats.  Monitor pollen counts daily.  Click Today’s Pollen Count to view the daily pollen count.  Stay indoors wherever possible when the pollen count is high (generally on dry warmer days).  Note that rain washes pollen from the air causing pollen counts to be lower on wet cooler days.  Avoid drying clothes outdoors when the pollen count is elevated.  Avoid contact lenses which may trap pollen in one’s eyes.  Since pollen is released in the early mornings, try to avoid exercising during this time.

The diagnosis and treatment of tree pollen allergies begins with a thorough history and physical examination by a board certified allergist.  Our board certified allergists in both adult and pediatric allergy at Black & Kletz Allergy have had more than 50 years of experience diagnosing and treating tree pollen allergies in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  After the history and physical examination, allergy testing is usually done by skin testing, or in some cases, by blood tests to confirm if the patient is in fact allergic to trees.  Once confirmed, there are a multitude of treatment options to alleviate the annoying symptoms of tree pollen allergies.  In addition to pollen avoidance measures in the above paragraph, the treatment of tree pollen allergies includes medications which can include oral medications (tablets, capsules, syrups, granules, etc.), nasal sprays, eye drops, and/or lung inhalers.  If there are additional environmental allergens that are found in a particular person which correlate with his/her symptoms during a different time of the year (Fall, Winter, etc.), then allergy shots (also referred to as “allergy immunotherapy” or “allergy desensitization”) may be a great way to treat the pollen allergy.  They are extremely effective and have been available for over 100 years.

If you would like a consultation for your hay fever symptoms, please do not hesitate to call Black & Kletz Allergy to make an appointment.  Alternatively, you can click Request an Appointment and we will get back in touch with you within 24 hours of the next business day.  We have 3 convenient locations in the Washington, DC metropolitan area with office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  There is parking at each location and the Washington, DC and McLean, VA locations are accessible by using the Metro.  Whether your hay fever symptoms are seasonal or perennial, we would be happy to help you.

As Winter approaches, people with dust, mold, and pet allergies tend to suffer more than those with pollen allergies.  Pollen levels in the mid-Atlantic region (Washington, DC, Virginia, Maryland, etc.) become immeasurable once the first frost occurs.  The first frost usually occurs by November in our region of the country.  Therefore, when people experience the typical allergy symptoms during the late Fall and Winter months, dust mites and/or molds are generally the culprits.  Keep in mind that there are other causes of these symptoms, namely the common cold, flu (influenza), or other upper respiratory tract infection (i.e., sinus infection, bronchitis).  How does one know the difference between winter allergies, a “cold,” the “flu” or other type of upper respiratory tract infection?

Winter Allergies – the same symptoms as seasonal allergies and can include all or some of the following:  runny nose, nasal congestion, post-nasal drip, sore throat, cough, sneezing, itchy nose, itchy eyes, watery eyes, red eyes, itchy throat, fatigue, sinus headaches, wheezing, and shortness of breath.

Common Cold – can include all or some of the above symptoms, but in addition may contain achiness, fever, and chills, although discolored nasal discharge and a fever do not occur in most cases of the common cold.

“Flu” (also referred to as influenza) – can include all or some of the symptoms of the common cold, but unlike a “cold,” there is usually severe achiness and/or headache, and a fever is almost always present.

Note:  For the flu season of 2014-2015, one must be cognizant of the recent Ebola epidemic in Western Africa.  If a person develops “flu-like” symptoms and has traveled to Western Africa and/or if they have been in contact with someone infected with the Ebola virus in the last 21 days, he or she must assume that they could have Ebola and should contact the CDC (Centers for Disease Control) and local county and state health agencies for guidance about seeking medical care at an appropriate hospital.  If one cannot get in touch with the CDC or local health agency, they should go immediately to closest emergency room.

Sinus Infection (also referred to as sinusitis) – can include all or some of the symptoms of the common cold, but unlike a “cold,” there usually is discolored nasal discharge, sinus pain and/or pain that radiates to the teeth.

Winter Allergies – Dust mites; Molds: Pets; Cockroaches

Common Cold – Viruses [Rhinoviruses, Coronaviruses, Parainfluenza viruses, and Respiratory syncytial virus (RSV) are the most common ones]; Note that there are many more viruses that cause the common cold. “Flu” – Viruses (Influenza virus types A, B, and/or C)

Sinus Infection – Viruses, Bacteria, and/or Fungi (Most are caused by viruses)

HOW ARE THESE CONDITIONS DIAGNOSED? Besides a thorough history of your symptoms and a physical examination, the following also help our physicians distinguish between the 4 common conditions below:

Winter Allergies – An experienced allergist can perform blood and/or skin tests to evaluate if you have a true allergy to one of the many allergens that can cause winter allergy symptoms.  When symptoms last longer than 1-2 weeks or there is a history of recurring symptoms every Winter or perennial (year-round) symptoms, allergies should be a top concern.

Common Cold – Typically the symptoms last less than 1 week in duration and resolve on their own.

“Flu” – A fever is the hallmark of this condition.  The flu can be very serious particularly in the elderly.  There are rapid influenza diagnostic tests that can identify the flu in about 30 minutes.  These require that the physician to wipe the inside of the back of one’s throat or nose with a swab and then send it for testing.  They are not 100% accurate however.

Sinus Infection – The symptoms may begin as a result of an individual being exposed to an allergen, virus, and/or bacteria.  A thorough history together with a complete examination of the ears, nose, mouth, and throat can usually identify a sinus infection in the majority of patients.  Further diagnostic studies such as a CT scan of the sinuses may be necessary in some individuals.  When there is recurrent sinus infections, the diagnosis of chronic sinusitis and/or an immunologic disorder should be investigated by an experienced allergist.

Winter Allergies – There are many allergy medications that can be used which include tablets, syrups, nasal sprays, and/or allergy shots (allergy immunotherapy or allergy injections).

Common Cold – Usually self-limited and generally does not require treatment except to help relieve symptoms with medications and nasal sprays.

“Flu” – Usually self-limited and generally does not require treatment except to help relieve symptoms with medications and nasal sprays.  Occasionally a severe case or a case in the elderly may need hospital care of complications from the flu which can include dehydration, pneumonia, and other more severe complications. Antiviral flu medications can be taken to reduce the duration and severity of the flu. These medications work best if they are taken within the first 48 hours of the beginning of symptoms, however they can still be effective if taken later.

Sinus Infection – May need to be treated with antibiotics if it persists or is recurrent.  Other medications may also be used if needed to help alleviate the symptoms with tablets, syrups, and/or nasal sprays.

Winter Allergies – Avoidance of dust mites, molds, and pet exposure.  Allergy medications and/or allergy shots (allergy immunotherapy or allergy injections).

Common Cold – Washing of hands; good hygiene; avoidance of crowded areas.

“Flu” – Flu vaccination (unless one has a reason not to take it such as egg allergy, previous reaction to the flu vaccine or the preservative used in the flu vaccine, etc.).  In addition, one should avoid exposure to people with the flu.  They should also practice good hygiene, avoid crowded areas during the flu season, wash their hands, etc.

Sinus Infection – Control allergies; washing of hands, good hygiene; avoidance of crowded areas.

As one can see from the information above, it may not be so easy for the average person to distinguish the difference between Winter allergies, the common cold, the flu, and a sinus infection.  Many of the symptoms are the same, similar, and/or overlap.  The board certified allergists at Black & Kletz Allergy have the expertise to help diagnose the correct ailment and more importantly, treat your problem.  We have 3 office locations in the Washington, DC metro and Virginia areas and we will be happy to schedule a visit for you at your earliest convenience.

Mold Allergies

As the temperatures are dropping and the leaves are starting to “fall”, the ragweed and other weed pollen counts are also gradually decreasing, but the mold spores will be a significant trigger of asthma and allergy symptoms in the coming few months for sensitized individuals.

Mold is a fungus which can cause bothersome symptoms in a few different ways:

  1. Allergic Reaction:  Though all of us are exposed to molds, only some of us develop “sensitivity” to them determined by our genetic composition.  When a genetically predisposed individual inhales spores from molds, his/her immune system considers them as foreign invaders and manufactures antibodies in an attempt to fight them.  These antibodies memorize the particular spores and “attack” them when they are exposed to them again.  This reaction causes certain chemicals like histamine to be released into the tissues which cause the typical symptoms of sneezing, stuffy/runny nose, itchy/watery eyes, etc. (Note: If your vision is seriously impaired, it may be a sign on something more severe, and you may wish to consult with a LASIK surgeon in Washington DC.)
  2. Irritant Reaction:  Molds can release substances called volatile organic compounds (VOC’s) which can irritate skin and mucus membranes inside the mouth, nose and eyes resulting in burning sensation, watery eyes, runny nose, scratchy throat and cough.
  3. Toxic Reaction:  Mycotoxins, produced by certain types of molds, in addition to causing irritant symptoms can also lead to flu-like symptoms, fatigue, headache, dizziness, and shortness of breath.
  4. Infection:  Though skin lesions are the most common infectious manifestation, different types of molds also can cause respiratory, gastrointestinal, and neurological disorders.

Molds are found in both indoor and outdoor environments and thrive in high humidity.  Moist and decaying leaves on the ground, which tend to peak in the Fall, form a substrate for the mold growth.  Damp basements, leaky faucets, wet shower curtains, and wet bathroom tiles also encourage proliferation of molds.  Though many mold overgrowths are visible, their spores are microscopic and are air-borne.  The most common types of molds that cause human suffering are alternariahormodendrumcladosporium and penicillium.

Most people sensitive to mold spores only exhibit “hay fever”- like symptoms involving the eyes, nose, mouth, and throat.  Less commonly, molds also play a role in more serious conditions like:

  1. Allergic Asthma:  In sensitized individuals with a history of asthma, mold spores can induce sudden and severe flare-ups of asthma symptoms which may require emergency treatments and/or cause an increase in the number or dose of controller medications.
  2. Allergic Bronchopulmonary Aspergillosis (ABPA):  It is a hypersensitive reaction to a particular type of mold called aspergillus in the lungs of patients with persistent asthma or cystic fibrosis.
  3. Allergic Fungal Sinusitis:  A chronic inflammatory response of the membranes and tissues inside the sinus cavities can be caused by certain types of molds in susceptible people.

Diagnosis:  Mold allergies can be detected either by skin testing or by measuring the amount of specific IgE antibodies in a blood sample by a clinical laboratory.  Skin testing is a more sensitive test and is the preferred method used by allergists.  A detailed history of the symptoms and their possible triggers in the environment followed by a focused physical examination will help the allergist in determining the type of testing needed to confirm the diagnosis.

Treatment:  The first principle in the management of any allergic disorder is to identify the possible triggering and aggravating factors in the environment and to avoid exposure to them to the extent possible.  To reduce exposure to the mold spores, the following measures can be quite useful:

  1. As dampness encourages mold growth, indoor humidity levels should be kept below 50 percent. Avoiding water leaks and running a dehumidifier in damp and musty areas of the house can also inhibit mold proliferation.
  2. Installing HEPA filters in HVAC systems and changing them periodically will reduce indoor spore counts by trapping them before fresh air is circulated.
  3. Adequate ventilation of the bathrooms either by running the exhaust fan or opening the windows will reduce mold growth.  Keep in mind that by opening the windows, outdoor molds may enter one’s home which can be counterintuitive.
  4. Proper care of indoor plants such as removing the dead leaves and avoiding standing water can be helpful.
  5. Wearing a face mask to cover the nose and the mouth before raking leaves and cutting grass will reduce exposure to molds substantially.
  6. Mold spore counts are usually higher at nights when the atmosphere is cool and damp.  Closing the windows will keep the outdoor molds from entering inside one’s home.

Medications like ocular, nasal, and oral antihistamines as well as nasal and inhaled anti-inflammatory drugs can relieve the misery of symptoms to a certain extent.  When environmental control measures and medications do not help enough or when the side effects of the drugs are bothersome, a desensitization process (i.e, allergy shots or allergy immunotherapy), which induces tolerance to the offending allergens, can be a long term solution which is highly efficacious.

The board certified physicians and staff at Black & Kletz Allergy have the training, expertise, and decades of experience in the diagnosis and treatment of adults and children with mold and other allergies in a professional, caring, and patient-friendly environment in the Washington, DC, Maryland, and Northern Virginia area.

Ragweed Allergies – What Are They and Do You Have Them?

As summer draws to a close and schools reopen across our region, most of us look forward to cooler days and fall colors. But if you are one of several million Americans who suffer from “Hay Fever” (“seasonal allergic rhinitis,” as it is more accurately named) to ragweed, the rising levels of pollen from ragweed are sure to increase your misery due to your allergic reaction to these pollen grains.

Though many weeds like Pigweed, Mugwort/Sagebrush, Cocklebur, and Russian thistle pollinate in the fall, Ragweed (species Ambrosia) is the most common and predominant allergen in our geographical area. Each plant can produce up to one billion pollen grains per season, and these can remain airborne for several days and travel hundreds of miles from the site of origin. In the Washington, DC metropolitan area, the ragweed pollen usually starts appearing in the air in mid-August. The pollen counts gradually increase and peak in early September and subside after the first frost which is usually in late October. Many scientists believe that rising temperatures and an increase in atmospheric carbon dioxide (CO2) levels may prolong the ragweed season.

When a person who has been previously sensitized to a particular pollen is exposed to that pollen in the air, the proteins trigger specialized cells in the immune system to release excessive levels of histamine and other chemical mediators which are responsible for various allergic symptoms, some of which are listed below:

  • Excessive sneezing
  • Itchy, red, puffy, watery eyes
  • Persistent runny nose
  • Nasal stuffiness, blockage, or congestion
  • Itchy throat and post-nasal drip leading to a dry cough
  • In asthmatic individuals, the pollen can also induce flare-ups of wheezing, chest tightness, cough and/or breathing difficulty.

In ragweed sensitive people, eating fresh fruits and vegetables like melons (cantaloupe, honeydew, watermelon, etc.), cucumber, zucchini, kiwi, and bananas may cause itching and tingling of mouth, tongue, and throat. This condition is called “pollen-food allergy syndrome” or “oral allergy syndrome” and is due to cross-reacting proteins in the pollen and fresh fruits.

A few avoidance measures can reduce the exposure to pollen and the suffering:

  • Minimize outdoor activities in the early morning hours when the pollen counts tend to be the highest.
  • Keep the windows at home and in automobiles closed and use air-conditioning.
  • Shower to remove pollen from the skin and hair after coming indoors and wash clothing.
  • Nasal irrigation can wash the pollen and irritants from nasal passages.

If the symptoms are bothersome, several medications like antihistamines (available in pills, liquid, nose sprays and eye drops), decongestants (pills and liquid), and corticosteroids (nasal sprays, pills, liquid), either alone or in combination may offer considerable relief. To be optimally effective, the medicines are best started a few days before the onset of the active season. For many people with moderate to severe sensitivity, allergy immunotherapy (also referred to as “allergy shots,” will cause a desensitization to that pollen, which in this case is ragweed pollen) will offer the most effective long-term relief from the symptoms and can reduce or eliminate the need for medications.

The physicians and Washington, DC allergy doctors at Black and Kletz Allergy practice in DC and northern Virginia have several decades of experience and expertise in managing ragweed sensitive patients and are committed to provide the most up to date and evidence based treatment options in a patient-friendly environment.

Hay Fever in the Washington, DC Area

Hay Fever in the DC area is manifested by tree and grass pollens in the Spring and ragweed pollen in the Fall.  More specifically, the tree pollen usually begins to pollinate towards the end of February each year and continue pollinating into May or even early June.  Grass pollen usually begins to pollinate in May and the peak of it is usually over by early July, but it still is present into August.  Ragweed pollinates usually beginning in mid-August and ends with the first frost which is usually in late October.  There are other weeds that cause hay fever in the DC area which are present throughout the Spring, Summer, and Fall.  The medical name for hay fever is “allergic rhinitis.”

Also read: What Is Hay Fever?

Another important allergen that affects many individuals in the Washington, DC area is mold.  People are exposed to mold spores and become sensitized to them, the same way that pollen causes sensitization in allergic patients.  Washington, DC was built on a swamp and therefore tends to always have mold in the air.  Mold tends to like damp and humid climates such as the DC area, however, some molds can exist and flourish in dry climates, even the desert.  Of course, molds are both an outdoor and indoor allergen and is found indoors primarily in basements, kitchens, and bathrooms which tend to be more damp.  The symptoms of hay fever may include nasal congestion, runny nose, sneezing, itchy nose, throat and/or eyes, watery eyes, red eyes, post nasal drip, sinus headaches, and/or fatigue. These symptoms are most bothersome after outdoor activities and many people feel that they are forced to isolate themselves indoors for several weeks when the weather is nice, resulting in a significant negative impact on their quality of life.  Many patients with asthma also experience cough, wheezing, chest tightness, and/or breathing difficulty on exposure to pollen.  These flare-ups can also cause sleep disturbances, unscheduled emergency visits to health care providers, and loss of work and school days.

Pollen counts are the highest on warm, dry, and windy days and are directly proportional to the “misery index” of the people who have been previously sensitized to the pollen. They also tend to be higher in the mornings and decrease temporarily after it rains.  Individuals that are sensitized to pollens have specific antibodies (called IgE antibodies) which interact with the antigen in the pollen, causing histamine and other chemicals to be released.  It is these chemicals that cause the symptoms of hay fever.  To alleviate hay fever symptoms, a few common sense precautions can help reduce the amount of exposure to pollen.  These precautions include closing the windows in homes and automobiles, keeping the sunroof closed in automobiles, minimizing outdoor activities on warm and windy days, and taking a shower after being outdoors.  Over the counter antihistamine medications can offer some relief from symptoms in mildly sensitized individuals but are not very helpful in people who have long term severe sensitivities to these pollens.  For people who continue to be symptomatic, however, more effective treatment options like prescription medications and/or allergy desensitization (immunotherapy) procedures offer long term relief, greatly improving the quality of life and increasing productivity.

Board certified allergists are physicians who have received advanced training in treating hay fever, asthma, and sinus conditions.  Black and Kletz Allergy practice has over five decades of experience in evaluating and treating hay fever in the DC area.  Feel free to contact us to schedule an appointment if you are experiencing hay fever or any other allergic or immunologic symptoms.


Top 7 Business Intelligence (BI) Trends For 2019

Top 7 Business Intelligence (BI) Trends For 2019
Top 7 Business Intelligence (BI) Trends For 2019

The new year is underway, and the search for the ‘next big thing’ to help increase a business’s chance of standing out against the competition in 2019 is paramount.

According to Gartner’s IT Glossary, Business Intelligence (B.I) is often defined as “an umbrella term that includes the applications, infrastructure and tools, and best practices that enable access to and analysis of information to improve and optimize decisions and performance”.

B.I models are essentially data-driven ‘Decision Support Systems’(DSS) that are used with the intention of better supporting a business. With B.I, visual data discovery, and business analytics solutions are continuing to evolve, which in turn is enabling non-technical users to interact with more types of data.

As a result, SavoyStewart pulled highlights from the report ‘2019 Business Intelligence Trends’ by Tableau, to reveal the major trends that will be shaping Business Intelligence in 2019.

1. The rise of explainable AI

The need for transparency has led to the growth of explainable Artificial Intelligence (A.I) – the practice of understanding and presenting transparent views into machine learning models.

Explainable A.I enables users to ask follow up questions as to why a model recommends something and what it would say if the inputs were different. According to Gartner Research, 85% of CIOs will be piloting A.I programmes to buy and build outsource efforts by 2020.

Companies have embraced the value of A.I but for it to make a disruptive impact it must be trusted, presenting valid conclusions that will help humans better understand their data.

2. Natural language humanises your data

Natural Language Processing (NLP) amalgamates computer sciences and linguistics to allow computers to better comprehend the meaning behind human language. With the natural language generation market estimated to grow to $825.3 million by 2023, B.I vendors are offering a natural language interface to .

3. Actionable analytics put data in context

B.I platforms are evolving to place data where people want to take subsequent action. For example, data workers need their data and actions in the same place, rather than performing an analysis and actioning it elsewhere. B.I platforms are closing this gap by merging with core business operations, workflows and processes such as analytics and dashboard extensions.

Business Intelligence Trends. Source: Saksoft

4. Codes of ethics catch up to data

5. Accelerated cloud data migration fuels modern B.I adoption

6. Data story telling is the new language of corporations

Data story telling will continue to permeate workplace culture and shape how organisations use data to engage, inform and test ideas. Often defined as using data visualisation as a language to convey information in a way that is actionable and easy to understand, data story telling is essentially sharing the steps they took to discover the insights of data.

As organisations create cultures of analytics, data story telling methods are more about nurturing a conversation about the data and not so much about arguing for a singular conclusion.

7. Enterprises get smarter about analytics adoption

Chief data officers are beginning to re-evaluate how B.I adoption plays a part in a strategy towards modernisation within their businesses. The report defines its true value as not “measured by a solution you deploy, but how your workplace uses the solution to impact business.”

Instead of adoption, leaders are focusing on whether data and analytics are changing the way that decisions are mad, through the evaluation of programs that encourage engagement like internal communities, to ensure they benefit the most from their B.I systems.


Exhibiting the Exhibition: From the Cabinet of Curiosities to the Curatorial Situation

Editorial: Hatje Cantz Verlag
Encuadernación: Hardcover
Idioma: English
Medidas: 22.00 x 33.00 cm

Exhibiting the Exhibition investigates the history of exhibiting up to the present day, from predecessors of the modern museum to 20th-century exhibition methods and curatorial positions.

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Magnet School Program

Established in 2015, PS 349 - The Magnet School of Leadership and Innovation through STEAM is designed to meet the needs of all children.  The rigorous curriculum and instruction engages students’ imagination through engineering and design, spark their innate curiosity in science, and engage students via exploration of the natural world. Our students have many opportunities to work together on hands-on STEAM projects that allow them to collaborate with their peers and lead through self – management, self–awareness and responsible decision-making. Students learn to be college and career ready and develop their leadership skills through the infusion of The Leader in Me and 7 Habits of Happy Kids within all curricula.

STEAM learning is infused into daily instruction, project-based learning, electives, and after-school programs. The principles of STEAM— critical thinking, inquiry, observation, exploration, and creation—at the heart of every content area discipline which allow students to think critically, communicate effectively, and innovate to solve real-world problems by engaging in authentic tasks.

PS 349 is a 1 to 1 technology environment where each student has access to their own iPad, MacBook or desktop computer to work on projects. In addition, the school uses Promethean boards in each classroom and technology supported programs such as robotics, coding and video conferencing with professionals in STEAM career fields.

As part of the Magnet Grant, PS 349 students have opportunities to participate in enrichment programs in conjunction with traditional curricula. We have partnered with community organizations to bring these special programs into our school community.

Student Enrichment

Our in-house library is a place where our students visit to gain a deeper love for books and reading. The library is designed to have different areas of exploration for the students. It is equipped with a multitude of books and technology to meet the needs of all learners. This is a place where students are able to relax and dive deep into a book of their choice.

As a STEAM school, we have integrated the use of many technological services for our students. Each of our modernized classrooms are equipped with a Promethean board for whole group instruction computer access. Using this piece of equipment, students are able to watch videos, participate in interactive learning activities, and conduct whole class research. In addition, each classroom houses Apple desktop computers, MacBooks, and iPads for students to use. Students have accounts with research-based literacy and math programs such as iReady to promote self-directed instruction.

Music and the Arts

PS 349 was awarded a grant for the Music and the Brain program. This program includes a comprehensive and engaging music literacy curriculum, teaching materials, ongoing teacher training, and a classroom keyboard lab to be used as part of the school's core curriculum.

Hydroponics Lab

PS 349 houses a hydroponic garden in the science lab where students have first-hand experiences with growing vegetables and herbs in a non-traditional way. There is also a hydroponic tower in the entryway of our school. Hydroponics as been proved to have several advantages over soil gardening. The growth rate on a hydroponic plant is 30-50% faster than a soil plant, grown under the same conditions. Hydroponic gardening offers several benefits to our environment. Hydroponic gardening uses considerably less water than soil gardening because of the constant reuse of nutrient solutions. Due to lack of necessity, fewer pesticides are used on hydroponic crops.

 Marquis Studios - The Arts for Kids Residencies

Marquis Studios has brought engaging learning opportunities to PS 349 students. To date, students have participated in the following residencies: African Dance, Architecture as a Study of Cultures, Bhangra Folk Dance, Collage, Creative Movement, Islamic Visual Arts and Culture, Mime, and Puppetry.

NY Hall of Science Residencies

The New York Hall of Science has brought hands-on science programs to PS 349 students. To date, students have participated in the following workshops: Bubble Brainstorm, Float, Sink, Design a Flink!, Mixing Color, Classy Classification, Five Senses, Lights and Shadows, Rockets, and Stuck on Magnets.

Music Partnership with Harmony Program

At the Harmony Program, music changes lives every day. Through collective music making, children explore new avenues and realize their full potential. Our specially trained teachers guide students from beginner group instruction to orchestral performance, building life skills and community from a shared love of music.

Every class at PS 349 has the opportunity to work with our specialized coding teacher. In this class, students learn the beginning stages of creating computer programs though games and interactive activities. Students then apply their coding knowledge to miniature Dash and Dot robots, where they control the movements, lighting, and sound of the device.

Project-Based Learning (PBL)

Students work on a project over an extended period of time that engages them in solving a real-world problem or answering a complex question. They demonstrate their knowledge and skills by developing a public product or presentation for a real audience. As a result, students develop a deep content knowledge as well as critical thinking, creativity, and communication skills in the context of creating an authentic, meaningful project. PBL unleashes a contagious, creative energy among both students and teachers.

The Magnet School for Leadership and Innovation Through STEAM

PS 349Q

88-08 164th Street

Jamaica, NY 11432

PS 349Q

88-08 164th Street

Jamaica, NY 11432

(718) 558-6220

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Haunted White Tiger Castle

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Haunted White Tiger Castle

A Card Adventure for the DragonScales FRPG

A medium ranked mini-adventure

The legends about the white tiger castle ruin are known by everyone in Concord mainly because the castle ruins can be seen from atop the eastern Concord walls. The castle is in ruins and it is known that the giant white tigers lair in and around the ruins waiting for dragons to appear. Every night the spirits of the castle appear with the setting sun. Then the ruins reform to a large castle filled with the ghosts of the castle. In the courtyard are spirit oxen and spirit war horses with ghosts to take care of them. Young dragons or older dragons new to the area swoop down into the courtyard expecting an easy meal. They pounce on ghost flesh. At the same time the white tigers leap from the castle parapets down onto the dragon killing and eating it.

As the bard sings about the castle your group of characters all have the exact same thought. For over a hundred years dragons have been killed in the courtyard of that castle. There could be several fortunes in dragonscales to be had for a little bit of risk.


Ada e Alfonso Sella

by Cristina Mirandola

What had started as a visit to a craft bookbindery ends up restoring a marriage to life: that of Ada and Alfonso Sella, who have been working together to “plant a seed in the hope that it sprouts,” to spread beauty, to help anybody who wants to “give a name” to plants and therefore to love them.
Alfonso Sella was a painter, engraver, botanist and dialectologist, he compiled a “Dictionary-Atlas of Biella’s speeches,” was a divulger of glottology and local botany and, in collaboration with his wife Ada, he devoted himself to the production of herbariums.
“The days of my youth are long gone, when Biella’s woods were intact, and not invaded by brambles and black locusts and inaccessible, when there were many little streams where we could quench our thirst and fish for shrimps, and in the biggest ones we could dive during the summer. Many areas of our soil have been violated and covered with grimes. But there are still places, especially on the mountains, that have resisted the assault and there we can experience nature.
When we take a ride through the countryside, our eyes are careful to seize any novelty, rarity, interesting or accidental combination, born by chance by the transformation of elements. The eyes train and the ability to seize opportunities becomes more lively. It is the hunter’s instinct that comes back with a positive ending. Birdwatching is much talked about, so why shouldn’t we talk about grasswatching, mosswatching, and the like?”*
If herbariums are “collections of plants, or of some parts of them, pressed and dried, and subsequently fixed to sheets of paper,”** the impulse and motivations that urge to the creation of a herbarium bring us to follow the tracks of a journey, a loving glance turned towards the world, a glance on small things, a glance that lets itself be amazed. The creation of these herbariums is really an act of love, “… The wish to classify, not with the cold purpose to pigeon-hole, but to give a name to some creatures that are cherished and admired, knowing that they will be dearer to me after having been identified”.** The search and collection of specimens to preserve are turned into a metaphoric journey about the love for discovery: “Wandering on foot has therefore become an important part of life: tours at the discovery of new things (and you don’t even need to go too far; the same mystery is everywhere and we can come across it in the herbs of the garden’s pavement) with watchful eyes, careful to seize any detail that has never been seen before”.**
So maybe a herbarium is really much more than a collection of pressed and dried plants, maybe it is a homage to amazement.

*L’erbario, di Alfonso e Ada Sella - Longanesi, 1974
**L’erbario. Alla ricerca delle forme vegetali,
Ada e Alfonso Sella - Centro Botanico, Milano, 1989

Informazioni bibliografiche / Bibliographic information
Per amare una pianta. Gli erbari di Alfonso e Ada Sella. Catalogo della mostra (Biella, 2005)
a cura di A. Soldano - DOCBI Centro Studi Biellesi


Click here to win prizes by solving the puzzle Advent calendar.
Click here to win prizes by solving the puzzle Advent calendar.

Coloured weights

You have six weights. Two of them are red, two are blue, two are green. One weight of each colour is heavier than the other; the three heavy weights all weigh the same, and the three lighter weights also weigh the same.
Using a scale twice, can you split the weights into two sets by weight?

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Sunday Afternoon Maths LXVII

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Concussion Research to Get $14 Million Boost
Business + Economy

Concussion Research to Get $14 Million Boost

REUTERS/USA Today Sports

Researchers in the U.S. on Monday unveiled a $14 million series of research projects aimed at diagnosing and treating brain injuries in football players and others who have suffered multiple head injuries or concussions.

The projects, partly funded by the National Football League, are aimed at chronic traumatic encephalopathy, or CTE, a condition linked to the loss of decision-making control, aggression and dementia. The condition is tied to repeated hits to the head, such as those experienced by football players, hockey players and boxers. The condition currently can be diagnosed only by examining a person's brain after their death. But researchers with the National Institutes of Health aim to develop tests to detect and treat CTE while the patient is alive.

Related:  The Big Business of College Football: Who's Winning?

"This is a public health problem," said Walter Koroshetz, deputy director of the NIH's National Institute of Neurological Disorders and Stroke. "We don't know the mechanics of the head injuries that lead to this, the number and severity that is required to get this. We don't know whether certain people based on their genes are more susceptible or not. There are a lot of questions to be answered."

The research is not focused just on football players, but any people who engage in activities in which they suffered head injury. Researchers say they also hope to better understand the potential relationship between traumatic brain injury and late-life neurodegenerative disorders, especially Alzheimer's disease.

Related:  Alzheimer's Funding Should Be a No Brainer

Two of the new research projects will focus on defining the long-term changes that occur in the brain years after a head injury or after multiple concussions. Ten neuropathologists from eight universities will work to describe the chronic effects of head injury in tissue taken from hundreds of individuals as they try to develop standards for diagnosis. Six pilot projects will aim to identify potential biomarkers that can be used to track a person's recovery from concussion.

Previous published research has found that former American football players have higher rates of neurodegenerative diseases such as Alzheimer's and Parkinson's disease. There has also been violent and erratic behavior noted among current and former NFL players, including a spate of suicides.

This month, the family of former Kansas City Chiefs' linebacker Jovan Belcher had his body exhumed so his brain could be studied for signs of CTE. Belcher killed his girlfriend and then himself last year. Also earlier this month, five former players for the Kansas City Chiefs football team sued the Chiefs, claiming to be suffering from CTE because of multiple concussions suffered while playing for the team.